Trump planning more action on Obamacare

TRUMP PLANNING MORE ACTION ON OBAMACARE — That’s according to Rep. Chris Collins — who served on President Donald Trump's transition team as his congressional liaison — and now says that Trump plans to use his administrative powers to dismantle large swaths of the health law well before Congress passes a replacement package.

— What Trump's actions will look like: The directives are likely to be aimed at rolling back elements written and implemented by federal agencies, and may simultaneously install new safeguards intended to keep the insurance markets stable.

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"You’ll potentially see some additional executive orders that will deal with market stability," Collins said at the GOP congressional retreat in Philadelphia, Pro's Adam Cancryn reports. Collins also said that Republicans are planning a two-year delay on any coverage changes that happen as part of Obamacare repeal and replacement.

64 days to reform Obamacare. That's the ambitious time frame that Speaker Paul Ryan gave GOP lawmakers in a closed-door session on Wednesday afternoon, saying that he wanted health reform to be done by the end of March.

According to Ryan, House Republicans will mark up their reconciliation package within the next few weeks and bring it to the floor as soon as late February.

Rep. Diane Black told reporters that the goal is to be ready to vote on the bill by the first week of March, at the latest.

Reminder: Democrats needed about 400 days to pass ACA. The exact number depends on whether you start counting from Jan. 3, 2009, with the gaveling in of the 111th Congress, or the White House health reform summit on March 5, 2009. Either way, it took Democrats at least 383 days and at most 442 days to get their health reform package through Congress.

On today’s agenda at the GOP retreat. From 10 am to noon: “Keeping our promise on health care” with a presentation from House Chairmen Greg Walden, Kevin Brady, and Virginia Foxx; Senate Chairmen Orrin Hatch and Lamar Alexander, Sen. John Barrasso of the Senate Republican Policy Committee, and Andrew Bremberg, assistant to the president and White House Domestic Policy CouncilDirector.

There's also a noon lunch with Trump, a 2 p.m. session with Vice President Mike Pence and a 7 p.m. dinner with retired NFL quarterback Peyton Manning.

THIS IS THURSDAY PULSE — Where we remember where we were 2,500 days ago, the day after then-President Obama signed the ACA into law: Drifting on our back in a hotel pool, staring up at the ceiling, and wondering if we'd ever cover anything like the health reform battle again. Little did we know. Send tips to ddiamond@politico.com or @ddiamond on Twitter.

Meet the new FTC chair — and her views on health care. Maureen Ohlhausen, who Trump named acting chair of the Federal Trade Commission Wednesday, has taken some strong views on health care matters, Pro's Darius Tahir points out.

Among the takeaways

1) She likes the potential of telemedicine;2) She wants to rethink regulators' approach to licensure;3) She's not a fan of certificate-of-need laws, which require state approval for new hospitals; and4) She also doesn't like pay-for-delay practices among large pharmaceutical companies that pay generic competitors to stay out of the market.

THE WHITE HOUSE

Trump calls Rep. Elijah Cummings on drug prices. The brief conversation on Wednesday, which Cummings' office confirmed to PULSE, didn't get into details, but was about how the president and the outspoken Maryland Democrat "can work together."

Cummings, the ranking member on the House Oversight and Government Reform Committee, led an investigation with Sen. Bernie Sanders into the rising prices of medicines, and Cummings pushed for House hearings on the topic last year.

Trump: My plan 'will be better health care for more people at less cost.' That's what the president told ABC News yesterday, in his first White House interview since the inauguration.

Health wonks pointed out: Trump's overlooking the likely trade-off. "The government can certainly spend less money and provide health insurance to fewer people," Kaiser Family Foundation's Larry Levitt wrote. "Spending less and covering more is trickier."

**A message from The John A. Hartford Foundation: The John A. Hartford Foundation believes older adults should receive high-quality health care that meets their goals and preferences. For more than 35 years, we’ve built a field of experts in aging and health. Consider us your resource for promoting cost-effective, age-friendly health systems through policy and practice. Learn more at johnahartford.org/improvingcare. **

TOM PRICE

Conservative group launching $1 million TV buy to boost Price. The ad campaign's message: Democrats are being obstructive.

The organization, 45Committee, will begin airing a new ad on Thursday hammering “D.C. insiders” for “playing politics” and “blocking the nominations of key cabinet secretaries like Dr. Tom Price," POLITICO's Alex Isenstadt reports. As the ad makes the charge, an image of Senate Majority Leader Chuck Schumer, who has been sharply critical of the nominee, flashes across the screen. More.

U.S. District Court Judge John Bates on Monday blocked Aetna’s proposed $37 billion acquisition of Humana. In a new court filing yesterday, Anthem’s attorneys argue the ruling essentially validates the company’s stance that $2.4 billion in medical savings that it claims will result from the deal should be viewed as a boon for consumers.

… Anthem’s contention is that those savings would far outpace any competitive harm that would result from the deal. The insurer further argues that the Aetna-Humana ruling backs up its criticism of the Justice Department’s assertion that there are only four national carriers competing for large employer accounts. Bates, they note, included Humana among the “Big 5” insurers that have dominated the industry.

But U.S. District Court Judge Amy Berman Jackson, in accepting the new filing, expressed skepticism about its relevance to the Anthem-Cigna case. Jackson stated that she “does not intend to adopt factual findings lifted from the Aetna opinion that were based on a record that was not presented to this court.”

What's next: A ruling is expected any day in the Anthem-Cigna case, and most prognosticators expect DOJ to succeed in blocking the deal.

EYE ON CONGRESS

Rand Paul: Get rid of Obamacare taxes. Republicans face a dilemma in repealing and replacing Obamacare: What do they do with the law’s taxes? If they immediately jettison them, there won’t be any money left to pay for a replacement package. That’s led some Republicans to support keeping the revenue streams in place, at least initially, until they decide on what Trumpcare will look like.

But Sen. Rand Paul, who introduced his own replacement package on Tuesday, threw cold water on that approach yesterday. “I don’t think that a lot of Republicans are going to want to keep the Obamacare taxes,” Paul said on a call with reporters. “Some Republicans may, but I don’t think it will end up being a consensus.”

Trump said in recent interviews that he wants to pursue Medicaid block grants and provide “insurance for everybody” — a phrase that put GOP lawmakers on the spot, and having to explain how they’re going to stack up against Obamacare's expansive coverage gains. The White House has also sent mixed messages on the future of the individual mandate and other ACA provisions.

— But some Republicans would welcome a Trump plan because it would likely clear the crowded field of Republican health bills and lay out priorities. “The process doesn’t work very well unless the executive proposes and the legislature disposes,” said Sen. Lamar Alexander — who caveats that “just because he recommends it doesn’t mean we have to do it, but it’s very helpful to have his recommendations." Keep reading: More for Pros.

Frustrated House Republicans press Mitch McConnell to kill the filibuster. The Senate Majority Leader took some friendly fire on Wednesday, as age-old tensions between the fast-moving House and plodding Senate percolated just hours into their three-day gathering. One flash point: The anti-abortion legislation passed by the House — and which the Senate is hesitating to take up, given Democrats' ability to stop it. Keep reading: More for Pros.

EYE ON THE HUMPHREY BUILDING

Federal judge blocks HHS rule on third-party payments. U.S. District Judge Amos Mazzant on Wednesday granted a temporary restraining order that prevents the rule — issued in December — from taking effect, concluding that HHS failed to follow proper rulemaking procedures. Mazzant previously issued an emergency stay on the rule earlier this month.

The Obama administration issued the rule after insurers complained that kidney care providers had been steering patients eligible for Medicare or Medicaid into private plans instead, seeking to reap higher payments. Three dialysis companies, Fresenius Medical Care, DaVita and U.S. Renal Care, filed a lawsuit to block the rule, saying it would harm patient care.

— Reaction: A spokesperson for DaVita said the company was not only "pleased" with the ruling but also urged the new administration "to take action to prevent insurance companies from discriminating against a vulnerable group of patients."

The American Kidney Fund celebrated too. “The regulation would have effectively ceded all decision-making to insurers, who are aggressively taking steps to bar dialysis patients from accessing their insurance plans," said LaVarne Burton, AKF's president.

Sixty-five senators voice support for Medicare Advantage. With some in the GOP pushing for Medicare reform, the bipartisan letter, led by Sens. Mike Crapo and Bill Nelson, asks CMS Acting Administrator Patrick Conway to "strengthen this vital and proven part of the [Medicare] program that has led the way on value-based care." Read the letter.

$24.3 billion in HHS contracts is set to expire in 2017. That's according to Govini, a business intelligence firm, which notes that the administration may allow many ACA-related contracts to lapse. "Industry should expect massive disruption," according to Govini's report previewed to PULSE. "Services contractors can expect the flow of work in their pipeline to slow to a trickle as most of their work is related to the implementation of the ACA."

AROUND THE NATION

North Carolina: U.S. DOJ, state Republicans are asking for pause on Medicaid lawsuit. The Justice Department and North Carolina state Republicans have asked a federal court to pause action for 60 days on the lawsuit contesting Gov. Roy Cooper's Medicaid expansion move, in order to give incoming Trump administration officials time to evaluate the case.

Under an existing order that expires Saturday, Cooper is temporarily blocked from submitting his Medicaid expansion plan to the federal government. The latest DOJ and North Carolina legislator request doesn't prevent that temporary block from ending, so technically, the Democratic governor could send his proposal to HHS. But federal officials have agreed to not act on the plan for 89 days, according to the motion filed Wednesday with the U.S. District Court for the Eastern District of North Carolina. "In no event will the proposal be approved by any federal government agency or official before 89 days have elapsed," the motion states.

...One of Cooper's first actions as North Carolina governor was to try to expand Medicaid under Obamacare via executive authority, but statehouse Republicans argue he is violating a 2013 state law that says the governor needs legislative approval. North Carolina would be the 32nd state to enact the Obamacare expansion.

Massachusetts: Governor wants return to pre-ACA health care options. In his budget message on Wednesday, Gov. Charlie Baker called for a return to the commonwealth's health care law before the Affordable Care Act was passed, reclaiming the state’s original mandate that employers provide a health care option, POLITICO's Lauren Dezenski reports.

That mandate changed once Obamacare went into effect, leading to a spike in the number of enrollees in Medicaid and Children’s Health Insurance Program, known as MassHealth. The number of enrollees who are employed full-time has nearly tripled since 2011, eating up a greater portion of the state’s annual budget — some $16.2 billion of the $40.5 billion proposed spend for the coming fiscal year.

… Baker's proposal would include requiring employers to contribute a minimum of $4,950 for employees working 35 hours, as well as a five-year moratorium on new coverage mandates. Baker’s budget would also make it easier for small business employees to access coverage with significantly lower premiums. More.

NAMES IN THE NEWS

Brunswick Group adds Hannah Stott-Bumsted, Raul Damas. Stott-Bumstead, who starts at the corporate advisory firm on Feb. 13, was most recently counselor to the deputy secretary at HHS. Damas, who was VP of communications at Purdue Pharma, joined this month.

WHAT WE'RE READING by Sarah Karlin-Smith

Health plans are quietly urging the Trump administration to give states more control of insurance oversight, tighten eligibility for ACA plans and other changes as GOP eyes an Obamacare replacement, Reuters reports. More.

Only 38 percent of primary care doctors who voted for Trump want Obamacare repealed, and just 15 percent of all primary care doctors do, according to a NEJM survey. More.

The American Action Forum's Tara O'Neill Hayes reviews and summarizes the GOP repeal-and-replace proposals, noting that many contain similar provisions. More.

Thanks to Trump, organizers say there's a new mood for this year's March for Life annual anti-abortion rally: Optimism. More.

**A message from The John A. Hartford Foundation: There are many ways to improve health care so older adults can continue to contribute to our communities and society. American ingenuity can replace ineffective, inefficient practices with new and better ways of delivering care.

Today’s health systems don’t always have immediate access to current best practices for meeting the unique needs of older adults. The John A. Hartford Foundation is addressing this challenge and has committed to making 20 percent of U.S. hospitals age-friendly by 2020. By consistently modeling and replicating evidence-based practices in health systems across the country, we can reliably deliver better care to older adults in every setting—resulting in less harm, better outcomes, satisfied patients, and lower overall costs.

The John A. Hartford Foundation is your resource for improving policy and practice that promotes cost-effective, age-friendly health systems. Learn about our areas of expertise at johnahartford.org/improvingcare. **

About The Author

Dan Diamond is the author of "POLITICO Pulse," the must-read morning briefing on health care politics and policy. He's also the creator of PULSE CHECK, the popular podcast that features weekly conversations with some of the most interesting and influential people in health care, — from politicians like Sen. Susan Collins to leaders like Kaiser Permanente’s Bernard Tyson and thinkers like Atul Gawande.

Before joining POLITICO, Diamond edited the Advisory Board Daily Briefing, served as the Advisory Board's senior director of news and communications and created and hosted the popular Weekly Briefing health care podcast. He also covered health care policy, business, and strategy for FORBES. His work has appeared at Vox, Kaiser Health News and other publications.

Diamond is a graduate of the University of Pennsylvania and has appeared to discuss health care, politics, and policy on NPR's "All Things Considered" and "1A," the NBC Nightly News, the BBC, CBS, MSNBC, the Dan Patrick Show, KQED's "Forum" and other programs. He was recently named a 2015-2016 fellow of the Association of Health Care Journalists.